Making the case for psychological interventions

At its February 2010 meeting, the APA Council approved strategic planning funding for the development of treatment guidelines and the appointment of an Advisory Steering Committee, which is chaired by Steven D. Hollon, PhD. The association has continued to move forward with this important collaboration between our Practice and Science Directorates to develop what we are now calling Clinical Practice Guidelines, to align our terminology with the rest of the health-care industry. These guidelines are important for our discipline in the evolving health-care system with its emphasis on evidence-based care, provider accountability and improved patient outcomes.

The development of clinical practice guidelines integrates evidence-based practice with clinically informed references through an accepted systematic and scientifically rigorous methodology to create condition-specific guidelines. Although clinical practice guidelines provide specific and actionable recommendations about treatment alternatives and guidance to improve clinical decision-making and patient care, they do not attempt to substitute for sound clinical judgment.

Psychology must assume an active role in defining the value of psychological interventions, or treatment decisions for patients receiving mental and behavioral health care will continue to be determined by guidelines from medicine and psychiatry. Guidelines are an opportunity to demonstrate the value of psychological interventions in a health care environment very heavily weighted toward biological interventions.

As emerging standards in health care are shifting the focus to accountability and outcomes, guidelines will increasingly be used by the health-care system to direct care. Variance in the provision of patient care is an issue across all health care in the country, and guidelines are a means of identifying and increasing the use of good practices. Guidelines are included in Electronic Health Records (EHRs) as clinical decision aids and influence the course of treatment for patients. Without psychologically informed guidelines, psychological interventions might not even be considered; however, with the inclusion of those guidelines in EHRs, more appropriate referrals for mental and behavioral health conditions can be facilitated.

We hope psychologists will recognize the value of clinical practice guidelines for the profession, for them as practitioners and for their patients. Psychology values the integration of science and practice as evidenced in many APA policies as well as clinical training models. With thousands of articles published per year, clinical practice guidelines are a means of bridging science and the practice of psychology through the synthesis of literature and patterns in findings. Guidelines are also a way to ensure that scientific evidence about psychological interventions is available to policy makers, other health-care providers and payers.

APA's Advisory Steering Committee of nine members has been hard at work for the past two years in developing APA's process for creating clinical practice guidelines in alignment with emerging standards in health care. The Advisory Steering Committee is developing a Manual of Procedures for guidelines development to describe the process APA is following, based on current standards described by the Institute of Medicine.

Topic-specific expert panels are being appointed to determine the scope of a systematic review, interpret the results of the review and draw recommendations. The panels for depressive disorders, obesity and post-traumatic stress disorder have been appointed, and the panel for depressive disorders has had its first meeting. APA is committed to recognizing and reviewing a breadth of perspectives and the involvement of stakeholders, including patients, in its guidelines development process.

For more information about the clinical practice guidelines development process, visit the APA Clinical Practice Guidelines Development page. As always, I encourage you to email me with your questions, concerns or ideas.